THE KERALA GOVERNMENT SERVANTS' MEDICAL ATTENDANCE RULES, 1960

PREAMBLE

In exercise of the powers under the proviso to Article 309 of the Constitution, the Governor is pleased to make the following rules:-

Rule - 1. Short title.

These rules may be known as "The Kerala Government Servants' Medical Attendance Rules, 1960".

Rule - 2. Extent of application.

(i)       These rules shall come into force with immediate effect, in suppression of all other rules on the subject, provided that all claims which might have accrued under any rules in force before the coming into force of these rules, will be dealt with and disposed of under the appropriate rules.

(ii)      In respect of Gazetted Officers belonging to the erstwhile Travancore-Cochin State, these rules shall apply with retrospective effect from 15th August 1956.

Rule - 3. Definitions.

For the purpose of these rules.

(a)      "Government servant" means a whole time Government servant employed under Government and under its rule making control and includes employees under the Central and other State Governments with whom reciprocal arrangements in respect of medical attendance have been entered into by Government, but does not include non-pensionable employees paid from Contingencies, Part-time Employees and Honorary Workers.

[1]Note:-Government servants shall also include Government servants under suspension and Honorary Nursing Sisters of Health Services Department.

(b)      "Government" means the State Government of Kerala.

 

(c)      "Authorized Medical Attendant" means the District Medical Officer of Health or Principals of Medical Colleges or Principals of Ayurveda Colleges or Superintendent of Ayurveda College Hospital, Trivandrum or Superintendent, Maternity Hospital, Poojappura or the Assistant District Medical Officer of Health of the District or the Assistant Director (Homoeo) whoever is in charge of the District Hospital as Superintendent in which the treatment is given, or the District Indigenous Medical Officer or such other Medical Officer as may be designated by general or special orders.

Note 1:-The District Medical Officer of Health or the Principals of Medical Colleges or the Assistant District Medical Officer of Health whoever is in charge of the District Hospital as Superintendent is hereby authorized to certify Medical Officers working in particular Government Medical Institutions as Authorized Medical Attendants for all Government servants stationed in specified local areas and their families provided that the District Medical Officer of Health or the Principals of Medical Colleges or Principals of Ayurveda Colleges and Superintendent of Ayurveda College Hospital, Trivandrum or Superintendent, Maternity Hospital, Poojappura or the Assistant District Medical Officer of Health as the case may be, shall invariably be the Authorized Medical Attendant for all officials in the District, whose salary exceeds [2][Rs. 7251 per mensem.

Note 2:- The District Medical Officer, Kottayam, even though he/she has no charge of District Hospital, Kottayam as Superintendent, shall be the Authorized Medical Attendant for Government servants drawing a salary of above [3][Rs. 725] per mensem and he/she is also authorized to publish the list of Authorized Medical Attendants in the District.

[Notification No. 90629/67/HLD. dated 23rd December 1967]

Note 3:- The Medical Officers who are Authorized Medical Attendants as per rule 3 (c) of the above rules, will not be considered as Authorized Medical Attendance during the period of their leave (except C.L.) since during this period they are not discharging the usual functions in their official capacity.

Note 4:- The Superintendents of Ophthalmic Hospital, Trivandrum, T.B. Hospital, Pulayanarcottah, Hospital for Mental Diseases at Trivandrum and Kozhikode, Leprosy Sanatorium, Nooranad and Director, T.B. Centre, Trivandrum as Authorized Medical Attendants for the treatment of Government servants and members of their families suffering from such Special Diseases and also for all treatments of staff working under them.

(d)      Government Medical Institution includes all Government Hospitals, Government Ayurveda and Homoeo Institutions, Primary and Secondary Health Centers, Public Health Laboratories and Special Institutions like T.B. Sanatorium, Leprosy Asylum and Mental Hospital maintained by Government for providing medical relief.

(e)      "Family" means and includes the wife or husband, children including adopted children, step-children, and parents wholly dependent upon the Government servant.

"Medical Attendance" means the professional advice and care during sickness or injury whether at a Government Medical Institution, or in the consulting rooms of the Authorized Medical Attendant or at the residence of a Government servant entitled under these rules to medical attendance at his residence. It includes such surgical treatment as is available at Government Medical Institutions or can suitably be given at a Government servant's residence or at the consulting rooms of the Authorized Medical Attendant as also Bacteriological, Pathological, X-Ray and other clinical examinations available at Government Medical Institutions.

(f)       "Medicines" do not include proprietary preparations for which equally effective alternative preparations are available, primary foods, tonics, dentures, [4][spectacles], toilet preparations or disinfectants.

Note: - The list of articles and medicines the cost of which cannot be reimbursed under the Medical Benefit Rules in respect of Allopathic Medicines, Indigenous Medicines and Homoeopathic Medicines, will be found in [5][Appendix A, Appendix B and Appendix B and Appendix C] respectively.

Rule - 4. Persons entitled to free medical attendance.

(1)     All Government servants are entitled to free of all charges except as expressly specified in these rules, to medical attendance by their Authorized Medical Attendant.

 

(2)     Government servants are entitled to free medical attendance irrespective of whether they are on duty or on leave anywhere within the State.

 

(3)     Families of a Government servant are entitled to medical attendance free of charge to the same extent as the Government servant himself except that they shall not be entitled to free medical attendance at their residence unless the Authorized Medical Attendant is of the opinion that the patient cannot be removed without grave risk to his/her health.

Rule - 5. Medical attendance at residence.

(1)     Subject to the provision of sub-rule (3) all Gazetted Government servants are entitled to free medical attendance at their residences by the Authorized Medical Attendant.

(2)     If the Authorized Medical Attendant certified that the condition of a patient entitled to free medical attendance under the rules is so serious that his removal to the Government Medical Institution is likely to cause serious deterioration in his condition, the patient will be entitled to medical attendance at his residence, notwithstanding the provisions in clause (1) above. This rule will also apply where there is no proper accommodation suitable to the status of the Government servant at the nearest appropriate Government Medical Institution.

(3)     Cases of medical attendance requiring hospitalization will normally be referred to a Government medical institution by the Authorized Medical Attendant for admission.

If hospitalization is not considered necessary but the treatment is expected to be prolonged i.e., over a period of more than ten days, the patient should be referred to the out-patient departments of a Government Medical Institution by the Authorized Medical Attendant at the earliest.

In such cases where a patient is referred to a Government Medical Institution for treatment by the Authorized Medical Attendant the medical authorities of the institution concerned may treat the patient at the out-patient department provided it is certified that the case did not require hospitalization but is one of prolonged nature requiring medical attendance at the out-patient department spreading over a period of more than ten days. The Medical Officer in charge of the case at the out-patient department will be regarded as the Authorized Medical Attendant, who would inter alia, advise hospitalization in cases where it is required.

If, in spite of the specific advice of the Authorized Medical Attendant or the Medical Officer in charge of the case at the out-patient department a patient does not seek admission in the Government Medical Institution, the Authorized Medical Attendant/the Medical Officer in charge of the case should certify to this effect, while issuing or countersigning the Essentiality Certificate which is necessary to be produced by the Government servant for the purpose of reimbursement. In such cases no reimbursement would be allowed.

If, however, owing to lack of accommodation, admission to a Government Medical Institution is not possible as advised by the Authorized Medical Attendant, reimbursement of expenses incurred on treatment will be permissible to the extent otherwise admissible under the rules.

A certificate to the effect that accommodation was not available in the Government Medical Institution shall be produced for claiming reimbursement.

(4)     A Medical Officer who attends on a patient entitled to free medical attendance at his residence or elsewhere, will be entitled to Travelling Allowance as for journeys on duty.

Rule - 6. Consultation with Specialists.

Persons entitled to free medical attendance under these rules are entitled to free medical attendance only of the Authorized Medical Attendant and for facilities available in Government Medical Institutions and such other Institution within the State or as may be specified under rule 8(2). Where the Authorized Medical Attendant considers it necessary to consult a Specialist, he can requisition the services of the nearest Specialist in Government service including Honorary Medical Officers and such person shall comply with the requisition.

Note 1:- Government does not undertake to provide Government servants with services of Specialists except to the extent mentioned above.

Note 2:- Free medical attendance under these rules is available either under Allopathic Systems or under other Systems of medicine like Homoeopathy, Ayurveda etc. But no person will be entitled to free medical attendance under more than one system simultaneously. Claims for reimbursement of medical expenses under these rules shall be accompanied by a declaration in the form given below in addition to all other documents prescribed under the rules for the claim.

DECLARATION

I.............................................................................................................. employed in the ........................Department (or)............................................. relationship..................................................... of mine, have/has been under treatment at the.............................................................Hospital/Dispensary/ at my/his residence during the period of treatment from .............................to ......................................... and I/he/she have/has received the benefit of one system of treatment and not taken advantage of more than one system simultaneously.

Station...................... Name and designation

Date.......................... .......................... Department

Rule - 7. Reimbursement of expenditure incurred outside the State.

The expenditure incurred by a patient entitled to free medical attendance under these rules, on medical treatment when stationed or travelling on duty outside the State will be reimbursed subject to the following conditions:-

(a)      The Director of Health Services should certify that the illness which necessitated the medical attendance was so sudden that immediate treatment was necessary and the treatment could not have awaited the return of the patient to the State.

(b)      The charges claimed are considered reasonable having regard to the circumstances of the case.

Rule - 7A. Reimbursement of expenditure incurred for "Special Treatment" outside the State.

The expenditure incurred by a patient entitled to free medical attendance under these rules for any special treatment obtained by him/her outside the State but within India will be reimbursed subject to the condition that the Director of Health Services Certifies.

(i)       that there were no facilities in the State for such special treatment.

 

(ii)      that the nature of the disease warranted the special treatment outside the State but within India by the Specialist concerned, and

 

(iii)     the charges claimed are reasonable.

Note 1:- Such treatment outside the State but within India shall be taken only with the prior sanction of the Director of Health Services on the recommendation of the Authorized Medical Attendant. The Director of Health Services while sanctioning such treatment shall specify the Institution in which the treatment is to be undergone.

Note 2:- Claims in respect of the under mentioned charges alone will be accepted for reimbursement of the extent indicated.

1.        Treatment charges (in full)

 

2.        Bed Charges (50 per cent only)

 

3.        Physicians /Surgeons fee (in full)

 

4.        Lab charges including X-ray, BCG, etc. (in full).

 

5.        Blood Bank charges (in full).

Rule - 7B. A Government servant or a member of his family or an attendant shall be entitled to T.A. at the following rates to and from the headquarters of the Authorized Medical Attendant.

(i)       Journey by Rail.

(a)      For the Government servants. Fare of the entitled class or of the lower class by which they actually travel, plus incidentals as for the journey on tour under the rules in force (but without halting allowance.)

(b)      For the members of their families. Fare of the class by which the Government servant is entitled to travel on tour under the rules in force or the lower class by which they actually travel.

Note:- The facility of travel by Air Conditioned Accommodation at Government expense is not admissible for journeys performed for receiving medical attendance and treatment.

(ii)      Journey by Road.

(a)      For the Government servants.- For the road portion of the journey or for journeys between stations connected by road only actual fare paid for the journey by bus or other public conveyance or road mileage as on tour admissible under the rules in force, whichever is less;

(b)      For the members of their families. Actual fare paid for the journey by bus or other public conveyance, or mileage allowance at half the rate of road mileage admissible to Government servants whichever is less.

(iii)     T.A. for an Attendant/Escort. An Attendant/Escort will be entitled to Travelling Allowance both ways at the rates admissible under this rule to a member of family of the Government servant concerned provided. It is certified in writing by the Authorized Medical Attendant that it is unsafe for the patient to travel unattended and that an Attendant/Escort is necessary to accompany him/her to the place of treatment. Similarly Travelling Allowance will also be admissible if it becomes necessary for an Attendant/Escort to travel again to fetch the patient on production of the necessary certificate mentioned.

Rule - 8. Special concessions in regard to medical treatment.

(1)     Government shall not be responsible for any expenditure incurred by a Government servant on medical treatment by admitting himself into a non-Government Institution or by consulting a Private Doctor, except as specifically provided in these rules.

 

(2)     The Director of Health Services may specify the Private Medical Institutions within the State to which a Government servant may resort for purposes of medical relief, provided that no Private Medical Institution shall be so notified where a Government Medical Institution capable of giving similar treatment exists within a radius of 5 miles.

 

(3)     Government servants who have no Government Medical Institutions within a radius of 5 miles of their station, may resort to such Private Institutions and the charges incurred by them would be reimbursed by Government to the extent they would have received such treatment free in a Government Institution or at the hands of an Authorized Medical Attendant.[6]

Note:- Private Institutions recognized for treatment in Rule 8 (3) should be resorted to only in cases of emergency and not as a routine course. Bills for reimbursement submitted as per the above rules should be certified by the nearest District Medical Officer of Health as to the emergency of each case.

(4)     The claims in this respect should be preferred within one month from the last date of treatment and submitted to the Authorized Medical Attendant. He will scrutinize the bills and return them to the party with his certificate.

Note:- In deserving cases in which the delays are not due to avoidable circumstances the Heads of Departments and District Collectors may condone delays up to one month.

(5)     The expenditure on this account will be debitable to the same head to which the Salary and Allowances of the Government servant concerned is debitable.

Rule - 9. Reimbursement of cost of medicine purchased.

(1)     Government servants who are allowed free medical attendance at their own residences or in the consulting rooms of the Authorized Medical Attendant are entitled to free supplies of medicines prescribed from Government Medical Institutions. But they should make their own arrangements to collect the medicines.

(2)     If drugs essential for the effective treatment of a patient entitled to free medical attendance are not available in the Government Medical Institution, they may be purchased from open market and the [cost of medicine including sales tax] incurred thereon reimbursed to the Government servant. No Government servant shall claim under this provision reimbursement of +[cost of medicine including sales tax] on account of purchase of items which are not "medicines" as defined in clause (f) of Rule 3.

Note:- In the case of antigens obtained from C.S.I.R. Centre for Bio Chemicals, Delhi, packing and postage charges will be reimbursable.

This amendment shall be deemed to have come into effect from 2nd May 1975.

(3)     Claims in this respect should be preferred by the Government servant concerned before the expiry of  [one month], shall be accompanied by vouchers and an Essentiality Certificate as below signed by the Medical Officer prescribing the medicines concerned, and countersigned by the Authorized Medical Attendant. The Vouchers also shall be countersigned by the Authorized Medical Attendant in token of having administered the medicine. When the claim is more than Rs. 100 the bill shall be countersigned by the Director of Health Services or the Director of Indigenous Medicines as the case may be. [The Heads of Departments will ensure that the claims in respect of non-reimbursable items are not accepted and that in cases of doubt the Director of Health Services/Director of Indigenous Medicine/ Director of Homoeopathy is consulted].

[Notification No. 37089/G2/75/HD. dated 4th December 1976]

Note:-1. The time limit of one month mentioned in the sub-rule shall be from the last date of treatment.

Note :-2. In deserving cases in which delay for presenting claims for reimbursements is not due to avoidable circumstances the District Officers of all Departments including the District Superintendents of Police may condone delay upto one month; and the Heads of Departments and District Collectors may condone such delays upto a period of 3 months. For condoning delays of more than 3 months, Government sanction from the Administrative Secretariat should be obtained.

Note :-3. The Vouchers shall include Cash Bills and Credit Bills. In the case of credit bills, the Government servant shall produce the cash bills within one month of reimbursement, failing which the amount reimbursed will be recouped from the pay of the Government servant concerned.

(4)     The Heads of Departments are competent to sanction reimbursement of medical expenses subject to the conditions and limitations under these rules, without limit of the maximum amount.

Explanation. When a Government servant receives medical treatment for any illness for a continuous period shall be deemed to be one occasion of illness and medical treatment shall be deemed to be continuous for the said illness notwithstanding the fact that there has been any cessation of treatment for any period not exceeding 10 days or that treatment has been rendered in more than one Government Medical Institution.

(5)     The medical charges incurred by a Government servant entitled to free medical attendance in connection with his treatment shall, in the event of his death, be reimbursed to his legal heirs.

(6)     Application for reimbursement of medical expenses should be made in the Form prescribed below. [Two copies of the application should be presented. The duplicate copy of the application should be attached to the bill presented at the Treasury.] Dubious claims should be counterchecked and false claims dealt with by the Head of Departments and Offices by taking appropriate action against the erring officials.

[7]FORM OF APPLICATION FOR CLAIMING REIMBURSEMENT OF MEDICAL EXPENSES OF GOVERNMENT SERVANTS AND THEIR FAMILIES.

(Separate form should be used for each patient)

1.        Name & Designation of Government servant (In Block Letters)

 

2.        Pay and Scale of Pay

 

3.        Office in which employed

 

4.        Place of duty

 

5.        Residential address

 

6.        (i) Name of patient and relationship of the Government servant to the patient.

(ii) If the patient is spouse of the employee, state whether he/she is employed, with details.

(iii) If employed, whether the Declaration of non-receipt of the claim in any form is attached

7.        Place at which the patient fell ill

HOSPITAL TREATMENT

8.        Whether hospitalized or not

9.        If hospitalized whether in Government Hospital or Private (Notified) and the name of Hospital

10.     If hospitalized outside the State

(i)       Whether the patient was on duty

(ii)      Name of Institution

11.     If on Special Treatment outside the State

(i)       Name of Institution

(ii)      Whether certificate of Director of Health Services as contemplated in Rule 7(a) is attached.

(iii)     Whether prior sanction of Director of Health Services has been obtained.

12.     Last date of treatment

CHARGES

13.     Details of amount claimed

(List of Medicines, Cash Memos and Essentiality Certificate should be attached)

(i)       Treatment in Government Hospital Medicines

(ii)      Treatment in Private Institutions

(bills to be certified indicating emergency of the case)

1.        Charges for Medicines

 

2.        Charges for Treatment

 

3.        Charges for Accommodation

 

4.        Charges for Laboratory Services etc.

 

5.        Charges for Diet.

14.     Total amount claimed.

(In figures and words).

15.     List of enclosures

1.        Essentiality Certificate

 

2.        List of Cash Bills.

 

3.        Certificate of Medical Officers

DECLARATION TO BE SIGNED BY THE GOVERNMENT SERVANT

I hereby declare that the statements given above are true to the best of my knowledge and belief and that the person from whom medical expenditure has been incurred is wholly dependent on me.

Place:............                                                                                                     

Signature of Government Servant

Date:.............

[8]OP/IP No..................

[9]FORM OF ESSENTIALITY CERTIFICATE

I certify that Shri/Smt........................................................................... employed in the .................................................................................has been under treatment at hospital/dispensary or at his/her residence for the period from........................ to .................and that the under mentioned medicines prescribed by me in this connection were essential for the recovery/prevention of serious deterioration in the condition of the patient. They do not include proprietary preparations for which cheaper substance of equal therapeutic value are available, nor preparations which are primary foods, tonics, toilet preparations or disinfectants.

It is certified that the case did not require hospitalization but is one of prolonged nature requiring medical attendance at the out-patient department spreading over a period of more than 10 days.

This patient was/has been suffering from..................................................................................... (Name of disease).

Date..................                                                                                       

Name & Designation of the Authorized                Medical Attendant.

(Office Seal) Name of Institution.

Rule - 10. Identification of Government servants.

(1)     Where an Authorized Medical Attendant is not sure of the identification of a person claiming to be a Government servant, he may insist that the Government servant concerned should produce an Identify Certificate from the Head of his Office.

(2)     Where a person claiming to be a Government servant is so ill that immediate treatment is necessary and the treatment cannot be postponed till the production of an Identity Certificate, the Authorized Medical Attendant can give necessary treatment to the person concerned and require him to produce a certificate within 1[one month] of his being able to do so. If he fails to do so, the cost of the treatment shall be recovered from the patient.

Rule - 11. Treatment of Government servants in out-patient departments.

In order to facilitate prompt treatment of Government servants in the out-patient department of a Hospital or Dispensary, the Doctor in charge of the Institution shall specify a time not exceeding one hour daily during which time Government servants resorting to the Institution for treatment will be given preference and treated first. Among the Government servants inter-seeking treatment at the outpatients' department, no preference shall be shown and the treatment will be on the basis of first-come first-served, except that Police Constables will be entitled to special priority.

Rule - 12. Preference for admission.

Government servants will be entitled to special preference for admission to the General or Special Wards of all Government Medical Institutions up to 15 per cent of the beds in the Institutions. They will not be liable to pay any charge in the General Wards. In Pay Wards, they shall pay 50 per cent of charges fixed for rent, light, fans, etc., and full diet charges.

Rule - 12A.

One Pay Ward Room shall be kept separate for the Nursing Staff of the Hospital, where sufficient number of Pay Ward Rooms are available. In hospitals where sufficient number of Pay Ward Rooms are not provided a small room, shall be set apart for the Nursing Staff.

If these rooms are at any time unoccupied either partially or in full, they should be made available for accommodation of other patients.

[G.O.(P) 809/63. dated 12th November 1963]

Rule - 13. Issue of Medical Certificates.

(1)     On a written requisition from a patient, the Medical Officer who treated the patient will issue a Certificate noting the dates of admission for treatment and discharge and diagnosis, free of charge.

(2)     The appropriate Medical Authority will issue a Medical Certificate to a Government servant free of charge on request.

(a)      at the time of first appointment;

 

(b)      for the purpose of confirmation in Government Service;

 

(c)      for application for leave on Medical Certificate, stating whether the person concerned requires leave and if so, for what period;

 

(d)      for rejoining duty on expiry of leave on Medical Certificate; and

 

(e)      on any other occasion where the Government requires the Government servant to produce a Certificate of Physical Fitness.